BIPOLOAR DISORDER AND TREATMENT

INTRODUCTION TO BIPOLAR DISORDER:-          Bipolar disorder or manic –depressive disorder is a psychiatric diagnosis that describes a category of mood episodes define by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood and one or more depressive episodes. The elevated moods are clinically referred to as mania or , if milder hypomania. Individuals who experiences manic episodes also commonly experience depressive episodes also commonly experience depressive episodes or symptoms, or mixed episodes in which features of both mania and depression are present at the same time. INTRODUCTION TO MANIA:-       Mania is more than just feeling good or even euphoric with true mania, people can be described by words like “frantic”, “hyperactive” or over –excited often a person’s thought and speech is so “fast” that it tumbles over itself and becomes fragmented by following tangents of thoughts and ideas cycling between mania and depression is the hallmark of bipolar disorder (previously called manic-depression) but there are other possible causes of mania.          Mania, the presence of which is a criterion for certain psychiatric diagnoses, is a state of abnormally elevated or irritable mood, arousal and/or energy levels. The word derives from the Greek “caviar” (mania).           In addition to mood disorder’s individuals may exhibit manic behavior as a result of drug intoxication, medication side effect, or malignancy. However mania is most often associated with bipolar disorder, where episodes of mania may alternate with episodes of major depression. The criteria for bipolar do not include depressive episodes and the presence of mania in the absence of depressive episodes is sufficient for a diagnosis. Regardless, even those who never experience depression experience cyclical changes in mood. These cycles are often affected by changes in sleep cycle, diurnal rhythms and environmental stressors.          Mania varies in intensity, from mild mania (known as hypomania) to fall-blown mania with psychotic features including hallucination and delusion naturally, since mania and hypomania have also been associated with creativity and artistic talent. SIGN AND SYMPTOMS        Characteristics of mania include rapid speech, racing thoughts, decreased need for sleep hyper sexuality, euphoria, impulsiveness, grandiosity and an uncontrollably intense interest in goal-directed activities. Some people also have physical symptoms such as sweating, pacing, and weight loss in full-blown mania, the manic person well feel as thought his or her goal trump all else, that his or her goal trump all else, that there are not exercise restraint in the pursuit of what they are after Hypomania is different, as it may cause little or no impairment in function. The hypo manic person’s connection with the external world, and its standards of interaction, remain intact, although intensity of moods is heightened. But those who suffer from prolonged unresolved hypomania do run the risk of developing full mania even realizing they have done so one of the most signatures of mania is what many have described as racing thoughts. There are usually instances in which the manic person is excessively distracted by objectively unimportant stimuli. This experience creates an absent mindedness where the manic individual thoughts totally preoccupy him or her, making him or her unable to keep track of time or be aware of anything besides the flow of thought. Racing thoughts also interfere with the ability to fall asleep.           Mania is always relative to the normal of intensity of the person being diagnosed with it, therefore, an easily-angered person may exhibits mania by getting even angrier even more quickly, and an intelligent person may adopt seemingly “genius” characteristics and an ability to perform and to articulate thought beyond what they can do in a normal mood but perhaps the easiest indicator of mania would be noticeably clinically depressed person becomes suddenly cheerful optimistic happy, and full of energy. Other element of mania may include delusions, hypersensitivity hyper sexuality,  hyperactivity impulsiveness, talkativeness, an internal pressure to keep talking (over-explanation) or rapid speech, grandiose ideas and plans, and decreased need for sleep (e.g. feeling rested after 3 or 4 hours of sleep) In manic and hypo manic cases the afflicted person may engage in out-of character behavior, such as questionable business transactions wasteful expenditures of money, risky sexual activity, recreational drug abuse, abnormal social interaction, or highly vocal arguments uncharacteristic of previous behaviors. These may increase stress in personal risk of relationships. Lead to problems at work and increase the altercation with law enforcement. There is a high risk of impulsively taking part in activity potentially harmful to self and other TREATMENT          Before beginning treatment for mania careful differential diagnosis must be performed to rule out non-psychiatric causes.          Acute mania in bipolar disorder is typically treated with mood stabilizers and antipsychotic medication. Note that these treatment need to be prescribed and monitored carefully to avoid harmful side effect such as neuronleptic malignant syndrome with the antipsychotic medication. It may be necessary to temporarily admit the patient involuntary unit the patient is stabilized. Antipsychotic and mood stabilizers help stabilize mood of those with mania or depression. They work by dopamine and allowing serotonin to still work, but in diminished capacity          When the manic behavior have gone, long-term treatment then focuses on prophylactic treatment to try to stabilize the patient’s mood, typically through a combination of pharmacotherapy and psychotherapy           Lithium is the classic mood stabilizer to prevent further manic and depressive episodes. Anticonvulsants such as valproic acid and carbamazepine are also used for prophylaxis. More recent drug solutions include lamotrigine clonazepam is also used           Verapamil a calcium- channel blocker is useful in the treatment of hypomania and in those cases were lithium and mood stabilizers are contraindicated or ineffective. Verpamil is effective for both short –term and long-term treatment.